This rule, OAR 411-317-0000, defines words and terms frequently
used to describe developmental disabilities services. These definitions apply
to all rules in OAR chapter 411, divisions 300 to 455, unless the context
Residential Program" means the distinct method for the delivery of home and
community-based services in a 24-hour residential setting by a provider
certified and endorsed under the rules in OAR chapter 411, division
(2) "24-Hour Residential
Setting" means a residential home, apartment, or duplex licensed by the
Department under ORS
in which home and community-based services are provided to individuals with
intellectual or developmental disabilities. A 24-hour residential setting is
considered a provider owned, controlled, or operated residential
(a) "Abuse" as it applies to a "child" as
those terms are defined in ORS
(b) "Abuse" as it applies to a "child in
care" as those terms are defined in ORS
(c) "Abuse" as it applies to an "adult" as
those terms are defined in ORS
(d) "Abuse" as it applies to an "elderly
person" or a "person with a disability" as those terms are defined in ORS
(e) "Abuse" as defined in ORS
as it applies to a resident of a "long-term care facility" as defined in ORS
(4) "Abuse Investigation" means
the investigation activities required by OAR chapter 407, division 045 or OAR
chapter 413, division 015.
"Abuse Investigator" means an abuse investigator specialist as described in OAR
(6) "Accident" means
an event that results in injury, or has the potential for injury, even if the
injury does not appear until after the event.
"Activities of Daily Living (ADL)" are
the basic personal everyday activities, such as eating, using the restroom,
grooming, dressing, bathing, and transferring. ADL services include, but are
not limited to the following:
personal hygiene - providing or assisting with needs, such as bathing (tub,
bed, bath, shower), hair care, grooming, shaving, nail care, foot care,
dressing, skin care, or oral hygiene.
(b) Toileting, bowel, and bladder care -
assisting to and from the bathroom, on and off toilet, commode, bedpan, urinal,
or other assistive device used for toileting, changing incontinence supplies,
following a toileting schedule, managing menses, cleansing an individual or
adjusting clothing related to toileting, emptying a catheter, drainage bag, or
assistive device, ostomy care, or bowel care.
(c) Mobility, transfers, and repositioning -
assisting with ambulation or transfers with or without assistive devices,
turning an individual or adjusting padding for physical comfort or pressure
relief, or encouraging or assisting with range-of-motion exercises.
(d) Nutrition - assisting with adequate fluid
intake or adequate nutrition, assisting with food intake (feeding), monitoring
to prevent choking or aspiration, assisting with adaptive utensils, cutting
food, and placing food, dishes, and utensils within reach for eating.
(8) "ADL" means "activities of
of Medication" means the act of placing a medication in or on the body of an
individual by a person responsible for the care of the individual and employed
by, or under contract to, the individual or as applicable their legal or
designated representative or a provider organization.
(10) "Administrator Review" means the
Director of the Department reviews a decision upon request, including the
documentation related to the decision, and issues a determination.
(11) "Adult" means an individual who is 18
years of age or older with an intellectual or developmental
(12) "Advocate" means a
person other than paid staff who has been selected by an individual or their
legal representative to help the individual understand and make decisions in
matters relating to identification of needs and choices of services, especially
when rights are at risk or have been violated.
(13) "Agency" means a public or private
community agency or organization certified by the Department under OAR chapter
411, division 323 to deliver developmental disabilities services.
(14) "Aids to Physical Functioning" means any
special equipment prescribed for an individual by a physician, therapist, or
dietician that maintains or enhances the physical functioning of the
Resources" mean possible resources, not including developmental disabilities
services, for the provision of supports to meet the needs of an individual.
Alternative resources include, but are not limited to, private or public
insurance, vocational rehabilitation services, supports available through the
Oregon Department of Education, or other community supports.
(16) "Annual Plan" means the written summary
a case manager completes for an individual who is not enrolled in waiver or
Community First Choice state plan services. An Annual Plan is not an ISP and is
not a plan of care for Medicaid purposes.
"Assessor" means a person who meets the
qualifications described in OAR 411-425-0035
, has been trained by the
Department to conduct an Oregon Needs Assessment, and is employed by the
Department or a case management entity.
(18) "Attendant Care" means an hourly service
that provides assistance with ADL, IADL, and health-related tasks through
cueing, monitoring, reassurance, redirection, set-up, hands-on, standby
assistance, and reminding. Attendant care is available through the Community
First Choice state plan.
"Authority" means "Oregon Health Authority".
(20) "Background Check" means a criminal
records check and abuse check in accordance with OAR chapter 407, division
(21) "Bedroom" means the
personal space and sleeping area of an individual receiving home and
community-based services in a provider owned, controlled, or operated
residential setting, as agreed to in the Residency Agreement.
(22) "Behavior Professional" means a behavior
consultant who is qualified to deliver professional behavior services in
accordance with OAR chapter 411, division 304.
(23) "Behavior Supports" means the emergency
crisis strategy, proactive strategy, reactive strategy, and recovery strategy,
included in a Positive Behavior Support Plan or Temporary Emergency Safety Plan
and delivered by a designated person to assist an individual with challenging
(24) "Brokerage" means an
entity or distinct operating unit within an existing entity that uses the
principles of self-determination to perform the functions associated with
planning and implementation of services for individuals with intellectual or
"Business Day" means any day Department business is conducted. A business day
is generally considered to be Monday through Friday from 8 am to 5 pm, and
excludes Saturday, Sunday, and federal and state legal holidays.
(26) "CAM" means "Centralized Abuse
Means the part of an
ISP that identifies the following:
employment goals and objectives for an individual.
(B) The services and supports needed to
achieve those goals.
people, agencies, and providers assigned to assist the individual to attain
(D) The obstacles to
the individual working in an individualized job in a competitive integrated
employment setting and the services and supports necessary to overcome those
(b) A Career
Development Plan is based on person-centered planning principles.
(28) "Case Management Contact"
means a reciprocal interaction between a case manager and an individual or
their legal or designated representative (as applicable).
(29) "Case Management Entity" means a CDDP, a
Brokerage, CIIS, or the Children's Residential Program of the
Services" means the functions performed by a case manager that are funded by
the Department. Case management services include, but are not limited to the
(a) Assessment of support
(b) Developing an ISP or
Annual Plan that may include authorized services.
(c) Information and referral for
(d) Monitoring the
effectiveness of services and supports.
"Case Manager" means a person who
delivers case management services or person-centered service planning for and
with individuals, meets the qualifications of OAR 411-415-0040
, and is employed
as one of the following:
(a) A personal agent
by a Brokerage.
(b) A services
coordinator by a CDDP.
services coordinator by the Department.
(32) "CDDP" means "Community Developmental
"Centers for Medicare and Medicaid Services" is the federal agency within the
United States Department of Health and Human Services responsible for the
administration of Medicaid, the Health Insurance Portability and Accountability
Act (HIPAA), and for overseeing Medicaid programs administered by the states
through survey and certification.
(34) "Centralized Abuse Management" means the
Department's electronic abuse and serious incident reporting system.
(35) "Challenging Behavior" means a behavior
due to an individual's disability preventing the individual from accomplishing
ADLs, IADLs, and health-related tasks, or threatening the health and safety of
the individual or others.
"Chemical Restraint" means the use of a psychotropic drug or other drugs for
punishment or to modify behavior in place of a meaningful behavior or treatment
(37) "Child" means an
individual under the age of 18.
(38) "Children's Health Insurance Program"
means Oregon medical coverage under Title XXI of the Social Security
In-Home Services" includes case management from a Department employed services
coordinator and the services authorized by the Department delivered through the
(a) The ICF/ID Behavioral
(b) The Medically Fragile
Medically Involved Children's Program.
(40) "CHIP" means the "Children's Health
means the expression of preference, opportunity for, and active role of an
individual in decision-making related to services received and from whom
services may be received including, but not limited to, case management,
providers, services, and service settings. Individuals are supported in
opportunities to make changes when so expressed. Choice may be communicated
through a variety of methods, including orally, through sign language, or by
other communication methods.
"Choice Advising" means the impartial sharing of information to individuals
with intellectual or developmental disabilities about the following:
(a) Case management options.
(b) Service options.
(c) Service setting options.
(d) Provider types.
(43) "CIIS" means "Children's Intensive
means the person directly impacted by an action that is the subject of a
(45) "CME" means
"Case Management Entity".
"CMS" means "Centers for Medicare and Medicaid Services".
(47) "Collective Bargaining Agreement" means
a contract based on negotiation between organized workers and their designated
employer for purposes of collective bargaining to determine wages, hours,
rules, and working conditions.
"Community Developmental Disabilities Program" means the entity that is
responsible for plan authorization, delivery, and monitoring of services for
individuals who are not enrolled in a Brokerage. A Community Developmental
Disabilities Program operates in a specific geographic service area of the
state under a contract with the Department, local mental health authority, or
other entity as contracted by the Department.
(49) "Community First Choice (K Plan)" means
the state plan amendment for Oregon authorized under section 1915(k) of the
Social Security Act.
"Community Living Supports" means attendant care, skills training, and relief
Transportation" means the ancillary service described in OAR 411-435-0050
enables an individual to gain access to community-based state plan and waiver
services, activities, and resources, not medical in nature. Community
transportation is provided in the area surrounding the home of the individual
commonly used by people in the same area to obtain ordinary goods and services.
Community transportation is available through the Community First Choice state
(52) "Complaint" means an
oral or written expression of dissatisfaction with a developmental disabilities
service or provider.
"Complaint Investigation" means the investigation of a non-abuse related
complaint that has been made to a proper authority.
(54) "Complaint Log" means a list of
"Completed Application" as defined in OAR 411-320-0020
(56) "Condition" means a provision attached
to a new or existing certificate, endorsement, or license that limits or
restricts the scope of the certificate, endorsement, or license, or imposes
additional requirements on the provider.
(57) "Continuing Services" means the
continuation of a developmental disabilities service following the request for
a hearing. Services continue until a Final Order is issued.
(58) "Cost Effective" means being responsible
and accountable with Department resources by offering less costly alternatives
when providing choices that adequately meet the support needs of an individual.
Less costly alternatives include other service settings available from the
Department and the utilization of assistive devices, natural supports,
environmental modifications, and alternative resources. Less costly
alternatives may include resources not paid for by the Department.
(60) "Day" means a
calendar day unless otherwise specified.
(61) "Day of Service" means the date from
12:00 a.m. to 11:59 p.m. an individual receives developmental disabilities
services, unless otherwise specified in the appropriate program-specific
(62) "Day Support
Activities" means attendant care supports, delivered by a provider agency
according to OAR chapter 411, division 450, that happen during scheduled,
intentional, structured activities in a non-residential setting. Day support
activities focus on maintaining or enhancing the skills an individual needs to
engage with the community.
Administrative Hearing Request" means form 0443DD.
(64) "Delegation" is the process by which a
registered nurse authorizes an unlicensed person to perform nursing tasks and
confirms that authorization in writing. Delegation may occur only after a
registered nurse follows all steps of the delegation process as outlined in OAR
chapter 851, division 047.
"Denial" means any 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.
(66) "Department" means the Oregon Department
of Human Services or a designee of the Oregon Department of Human
Representative" means a person authorized by the Department to represent the
Department in a hearing as described in OAR 411-001-0500
(68) "Department Staff" means a person
employed by the Department who is knowledgeable in a particular subject
(69) "Designated Person"
means the person who implements the behavior supports identified in an
individual's Positive Behavior Support Plan. An individual's designated person
may include, but is not limited to, an individual's parent, family member,
primary caregiver, or service provider.
Means a person who is 18 years of age or
older, such as a parent, family member, guardian, or advocate, who is:
(A) Chosen by an individual or their legal
(B) Not a paid
provider for the individual.
Authorized by the individual, or as applicable their legal representative, to
serve as the representative of the individual, or as applicable, their legal
representative, in connection with the provision of funded supports.
(b) The power to act as a
designated representative is valid until an individual modifies the
(c) An individual or
their legal representative is not required to appoint a designated
"Developmental Disability" as defined in OAR 411-320-0020
"Developmental Disabilities Services"
mean the following services provided by, or authorized by, a CDDP, Brokerage,
or the Department:
(a) Case management
services as described in OAR chapter 411, division 415.
(b) Services available through the Community
First Choice state plan.
Services available through a 1915(c) waiver.
(d) State Plan personal care services as
described in OAR chapter 411, division 455.
(73) "Direct Nursing Services" mean the
services described in OAR chapter 411, division 380 determined medically
necessary to support an individual with complex health management support needs
in their home and community. Direct nursing services are provided on a shift
means the Director of the Oregon Department of Human Services, Office of
Developmental Disabilities Services, or the designee of the Director, which may
include Department Staff.
"Domestic Animals" means the animals domesticated so as to live and breed in a
tame condition, such as dogs, cats, and domesticated farm stock.
(76) "Emergency Crisis Strategy" means the
behavior supports used when an individual is in imminent danger of injuring
self or others.
Means an individual
receives care from any of the following:
An urgent care center.
medical technicians regardless of whether the individual is
(D) A psychiatric
intervention team regardless of whether the individual is
(E) Care delivered in
a physician's office that is typically received in an emergency room or urgent
Emergency medical care does not include medical care by a paid provider or
routine physical health care at an urgent care center or emergency
Physical Restraint" means a manual physical restraint that is:
(a) Part of an ODDS approved behavior
Delivered by a designated person trained to deliver the intervention.
(c) Not a safeguarding
(d) Not included in a
Positive Behavior Support Plan or not agreed to in an individually-based
"Employer" means, for the purposes of obtaining services through a personal
support worker, the common law employer. The common law employer is the
individual, or a person selected by the individual or their legal
representative, to conduct the responsibilities of an employer. An employer may
also be a designated representative.
"Employer-Related Supports" mean the
activities that assist an individual, and when applicable their legal or
designated representative or family members, with directing and supervising the
provision of services described in the ISP for the individual. Employer-related
supports may include, but are not limited to, the following:
(a) Education about employer
to basic wage and hour issues.
Use of common employer-related tools, such as Service Agreements.
(d) Fiscal intermediary services.
"Employment Service" means a
home and community-based service that supports the primary objective of
exploring, obtaining, maintaining, or advancing in an individual job in a
competitive integrated employment setting in the general workforce.
Employment services under the rules in
OAR chapter 411, division 345 include the following:
Individual Employment Support.
(I) Job Coaching.
(II) Job Development.
(ii) Small Group Employment
(C) Employment Path
services do not include vocational assessments in sheltered workshop settings
or facility-based settings. Employment services do not include new participants
in sheltered workshop settings.
(82) "Entity" means a person, a trust or
estate, a partnership, a corporation (including associations, joint stock
companies, and insurance companies), a state, or a political subdivision or
instrumentality, including a municipal corporation of a state.
(83) "Entry" means initial enrollment to a
Department-funded developmental disabilities service delivered by a provider
agency or case management entity.
(84) "Exclusive Focus" means there is at
least one provider or staff assigned to a single individual with the sole
responsibility of attending to the individual's health, safety, supervision, or
personal care needs.
means termination or discontinuance of a Department-funded developmental
(87) "Family Member" means spouse,
domestic partner, natural parent, child, sibling, adopted child, adoptive
parent, stepparent, stepchild, stepbrother, stepsister, father-in-law,
mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law,
grandparent, grandchild, aunt, uncle, niece, nephew, or first cousin.
(88) "Founded Report" means the determination
by the Department or Law Enforcement Authority (LEA), based on the evidence
that there is reasonable cause to believe that conduct in violation of the
child abuse statutes or rules has occurred and such conduct is attributable to
the person alleged to have engaged in the conduct.
(89) "Functional Alternative Behavior" means
a replacement behavior to an identified challenging behavior that achieves the
same outcome as the challenging behavior.
"Functional Behavior Assessment" means
the document written by a behavior professional in accordance with OAR
that describes an individual's challenging behavior and the
underlying causes or functions of the challenging behavior.
(91) "Functional Needs Assessment" means the
comprehensive assessment or reassessment that documents physical, mental, and
social functioning as determined by the Oregon Needs Assessment.
"General Business Provider" means an
organization or entity selected by an individual or their legal representative
and paid with Department funds that:
primarily in business to provide the service chosen by the individual or their
legal representative to the general public.
(b) Provides services for the individual
through employees, contractors, or volunteers.
(c) Receives compensation to recruit,
supervise, and pay the person who actually provides support for the
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.
"Guardian" means the parent for an individual under the age of 18, or a person
or agency appointed and authorized by a court to make decisions about services
for an individual.
Care Advocate" means the person authorized to make certain health care
decisions according to OAR chapter 411, division 390.
(96) "Health Care Provider" means the person
or health care facility licensed, certified, or otherwise authorized or
permitted by Oregon law to administer health care in the ordinary course of
business or practice of a profession. Examples of a health care provider
include, but are not limited to, a registered nurse (RN), nurse practitioner
(NP), licensed practical nurse (LPN), medical doctor (MD), osteopathic
physician (DO), chiropractor, respiratory therapist (RT), physical therapist
(PT), physician assistant (PA), dentist, or occupational therapist
(97) "Health Care
Representative" as defined in ORS
"Hearing" means a contested
case hearing subject to OAR 137-003-0501
, which results in a
"Home" means the
primary residence for an individual that is not under contract with the
Department to provide services certified as a foster home for children under
OAR chapter 411, division 346, licensed as a foster home for adults under OAR
chapter 411, division 360, or a licensed or certified residential care
facility, assisted living facility, nursing facility, or other residential
(a) A home for a child may include a
foster home funded by Child Welfare.
(b) A foster home funded by Child Welfare is
considered a provider owned, controlled, or operated residential
Community-Based Services" are services provided in the home or community of an
Home and community-based
services are authorized under the following Medicaid authorities:
(A) 1915(c) - HCBS Waivers.
(B) 1915(i) - State Plan HCBS.
(C) 1915(k) - Community First Choice (K State
and community-based services are delivered through the following program areas:
(A) Oregon Department of Human Services,
Aging and People with Disabilities.
(B) Oregon Department of Human Services,
Office of Developmental Disabilities Services.
(C) Oregon Health Authority.
(c) Home and community-based
services may include alternative resources specifically authorized as home and
community-based by the Department or Authority.
"Home and Community-Based Setting"
means a physical location meeting the qualities of OAR 411-004-0020
individual receives home and community-based services.
"Hospital Level of Care" means a child:
(a) Has a documented medical condition and
demonstrates the need for active treatment as assessed by the Clinical
(b) The medical condition
requires the care and treatment of services normally provided in an acute
"Host Home Program" means a provider agency certified and endorsed according to
OAR chapter 411, division 323 to operate a licensed host home according to OAR
chapter 411, division 348.
"HSD" means Health Systems Division, Medical Assistance Programs under the
Oregon Health Authority.
Medical Programs" means the medical programs under HSD including, but not
limited to, the MAGI Medicaid and CHIP programs described in OAR chapter 410,
division 200. "Health Systems Division Medical Programs" is further defined in
means "instrumental activities of daily living".
(107) "ICF/IID" means "Intermediate Care
Facility for Individuals with Intellectual Disabilities".
"ICF/IID Level of Care" means an
individual meets the following institutional level of care for an intermediate
care facility for individuals with intellectual disabilities:
The individual has an intellectual
disability or a developmental disability as defined in this rule and meets the
eligibility criteria in OAR 411-320-0080
for developmental disabilities
The individual has a
significant impairment in one or more areas of major life activity as defined
by federal regulation and assessed by the functional needs assessment,
(B) Receptive and expressive
(E) Self-direction; and
(F) Capacity for independent
"IEP" means "Individualized Education Program".
"Incident Report" means the written
report that includes all of the following:
Name of the individual who is the subject of the incident.
(b) Date, time, duration, type, and location
of the incident.
prior to, or leading to, the incident.
(d) Detailed description of the incident,
including staff response.
Description of injury, if injury occurred.
(f) Name of staff, including their position
title, and witnesses to the incident.
(g) Follow-up to be taken to prevent a
recurrence of the incident.
(111) "Independence" means the extent to
which an individual exerts control and choice over their own life.
"Independent Provider" means:
(a) A personal support worker; or
(b) An independent contractor delivering
services including, but not limited to, nursing services, discovery, job
development, or professional behavior services.
(113) "Individual" means a child, young
adult, or an adult, applying for, or determined eligible for, Department-funded
developmental disabilities services.
(114) "Individualized Education Program"
means the written plan of instructional goals and objectives developed in
conference with an individual, their parent or legal representative (as
applicable), teacher, and a representative of the public school
Limitation" means any limitation to the qualities outlined in OAR
(1)(d) and (2)(d) to (2)(j), due to health and safety risks. An
individually-based limitation is based on specific assessed need and only
implemented with the informed consent of the individual or, as applicable,
their legal representative, as described in OAR 411-004-0040
(116) "Individual Support Plan" includes the
written details of the supports, activities, and resources required for an
individual to achieve and maintain personal outcomes and health and safety. The
ISP is developed at least annually to reflect decisions and agreements made
during a person-centered process of planning and information gathering. The ISP
reflects services and supports that are important to meet the needs of the
individual identified through a functional needs assessment as well as the
preference of the individual for providers and the delivery and frequency of
services and supports. The ISP is the plan of care for Medicaid purposes and
reflects whether services are provided through a waiver, the Community First
Choice state plan, natural supports, or alternative resources.
(117) "Instrumental Activities of Daily
Living" are the activities other than activities of daily living required to
continue independent living as described in the Community First Choice state
Employment Setting" means employment at a location where an employee interacts
with other persons who are not individuals with disabilities (not including
supervisory personnel or individuals who are providing services to such
employee) to the same extent that individuals who are not individuals with
disabilities and who are in comparable positions interact with other persons;
and that, as appropriate, presents opportunities for advancement that are
similar to those for other employees who are not individuals with disabilities
and who have similar positions. Employment in an Integrated Employment Setting
cannot be facility-based work in a Sheltered Workshop and cannot be non-work
activities such as day support activities.
"Integration" as defined in ORS
(a) Use by individuals receiving
developmental disabilities services of the same community resources used by and
available to other people.
Participation by individuals receiving developmental disabilities services in
the same community activities in which people without disabilities participate,
together with regular contact with people without disabilities.
(c) Residence by individuals receiving
developmental disabilities services in homes or in home-like settings that are
in proximity to community resources, together with regular contact with people
without disabilities in their community.
"Intellectual Disability" as defined in
"Involuntary Reduction" means a provider has made the decision to reduce
services provided to an individual without prior approval from the
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
(124) "ISP" means
"Individual Support Plan".
"ISP Team" means a team composed of an individual receiving services and their
legal or designated representative (as applicable), case manager, and others
chosen by the individual, or as applicable their legal representative, such as
providers and family members.
"Legal Representative" means a person who has the legal authority to act for an
individual. The legal representative only has authority to act within the scope
and limits of their authority as designated by a court or other agreement. A
legal representative acting outside of their authority or scope must meet the
definition of designated representative.
For an individual under the age of 18, the legal representative is the parent,
unless a court appoints another person or agency to act as the
(b) For an individual 18
years of age or older, the legal representative is the guardian appointed by a
court order or the legally designated health care representative, where the
court order or the written designation provides authority for the appointed or
designated person to make the decisions indicated where the term "legal
representative" is used.
(127) "Level of Care" means ICF/IID Level of
Care, Hospital Level of Care, or Nursing Facility Level of Care.
"MAGI" means "Modified Adjusted Gross
Income". "MAGI" is further defined in OAR 410-200-0015
(129) "Mandatory Reporter" means any "public
or private official" as defined in ORS
"Mechanical Restraint" means any
mechanical device, material, object, or equipment attached or adjacent to the
body of an individual that the individual cannot easily remove or easily
negotiate around that restricts freedom of movement or access to the body of
the individual. Mechanical restraint is not:
(a) The use of acceptable infant safety
(b) The use of car safety
systems, consistent with applicable state law for people without
equipment when ordered by a physician or health care provider and approved by
the ISP team.
"Medicaid Agency Identification Number" means the numeric identifier assigned
by the Department to a provider following the enrollment of the provider as
described in OAR chapter 411, division 370.
(132) "Medicaid Performing Provider Number"
means the numeric identifier assigned by the Department to an entity or person
following the enrollment of the entity or person to deliver Medicaid funded
services as described in OAR chapter 411, division 370. The Medicaid Performing
Provider Number is used by the rendering provider for identification and
billing purposes associated with service authorizations and payments.
"Medicaid Title XIX Benefit Package"
means only the Medicaid benefit packages provided under OAR 410-120-1210
and (b), excluding individuals receiving CHIP Title XXI benefits.
(134) "Medication" means any drug, chemical,
compound, suspension, or preparation in suitable form for use as a curative or
remedial substance taken either internally or externally by any
means the following:
A medication to
address a condition or illness that, if the condition or illness is left
untreated may likely result in hospitalization or bodily injury, was:
(A) Taken in the wrong dosage; or
(B) Administered by the wrong route;
(C) Not given.
(b) A medication was given to a
person for whom it was not prescribed.
(136) "Medication Error with Adverse
Consequences" means any medication error that results in direct harm or
jeopardizes an individual's health and safety resulting in emergency treatment
or a required call to the prescriber.
(137) "Monitoring" means the periodic review
of the implementation of services and supports identified in an Individual
Support Plan or Annual Plan, and the quality of services delivered by other
(a) For a child, the parental
responsibilities for the child and the voluntary resources available to the
child from their relatives, friends, neighbors, and the community, that are not
paid for by the Department.
an adult, the voluntary resources available to an adult from their relatives,
friends, significant others, neighbors, roommates, and the community, that are
not paid for by the Department.
(139) "Notice of Involuntary Reduction,
Transfer, or Exit" means form 0719DD. This form is part of the AFH/DD Mandatory
Written Notice of Exit or Transfer.
(140) "Notification of Planned Action" means
form 0947. The Notification of Planned Action is the written decision notice
issued to an individual in the event that a developmental disabilities service
is denied, reduced, suspended, or terminated.
(141) "Nurse" means a person who holds a
current license from the Oregon Board of Nursing as a registered nurse or
licensed practical nurse pursuant to ORS chapter 678.
"Nursing Facility Level of Care" means
Has a documented medical
condition that demonstrates the need for active treatment as assessed by the
Clinical Criteria as defined in OAR 411-300-0110
(b) The medical condition requires the care
and treatment of services normally provided in a nursing facility.
"Nursing Service Plan" means
the plan that is developed by a registered nurse based on an initial nursing
assessment, reassessment, or an update made to a nursing assessment as the
result of a monitoring visit.
(a) The Nursing
Service Plan is specific to an individual and identifies their diagnoses and
health needs and any service coordination, teaching, or delegation
(b) The Nursing Service
Plan is separate from the ISP as well as any service plans developed by other
(144) "Nursing Tasks" mean the care or
services that require the education and training of a licensed professional
nurse to perform. Nursing tasks may be delegated.
(145) "OAH" means "Office of Administrative
(146) "OCCS" means
(147) "OCCS Medical
Programs" means "HSD Medical Programs".
(148) "ODDS" means the Oregon Department of
Human Services, Office of Developmental Disabilities Services.
(149) "OHA" means "Oregon Health
(150) "OHP" means
"Oregon Health Plan".
Adult" means an adult at least 65 years of age.
(152) "ONA" means "Oregon Needs
(153) "Oregon Health
Authority" means the agency established in ORS chapter 413 that administers the
funds for Titles XIX and XXI of the Social Security Act. The Oregon Health
Authority is the single state agency for the administration of the medical
assistance program under ORS chapter 414.
"Oregon Needs Assessment" means the
tool described in OAR 411-425-0055
maintained in the Department's electronic
payment and reporting system.
"Oregon Supplemental Income Program-Medical" is Oregon Medicaid insurance
coverage for individuals who meet the eligibility criteria described in OAR
(156) "OSIPM" means
"Oregon Supplemental Income Program-Medical".
(157) "OTIS" means the Oregon Department of
Human Services, Office of Training, Investigations, and Safety.
(158) "Parent" means the biological parent,
adoptive parent, or stepparent of a child. Unless otherwise specified,
references to parent also include a person chosen by the parent or guardian to
serve as their designated representative in connection with the provision of
Means a timely
and formal or informal process driven by an individual, includes people chosen
by the individual, ensures the individual directs the process to the maximum
extent possible, and enables the individual to make informed choices and
decisions consistent with
Person-centered planning includes
gathering and organizing information to reflect what is important to and for
the individual and to help:
(A) Determine and
describe choices about personal goals, activities, services, providers, service
settings, risks, and lifestyle preferences.
(B) Design strategies and networks of support
to achieve goals and a preferred lifestyle using individual strengths,
relationships, and resources.
Identify, use, and strengthen naturally occurring opportunities for support at
home and in the community.
(c) The methods for gathering information
vary, but all are consistent with the cultural considerations, needs, and
preferences of the individual.
"Personal Agent" means a person who:
(a) Is a case manager for the provision of
case management services.
the person-centered plan coordinator for an individual as defined in the
Community First Choice state plan.
(c) Works directly with individuals, and if
applicable their legal or designated representatives and families, to provide
or arrange for support services.
"Personal Support Worker":
Means a person:
(A) Who has a Medicaid provider
(B) Who is hired or
selected by an individual or their representative.
(C) Who receives money from the Department
for the purpose of delivering services to the individual in the home or
community of the individual.
Whose compensation for providing services is provided in whole or in part
through the Department.
(b) This definition of personal support
worker is intended to be interpreted consistently with ORS
(162) "Physical Aggression" means
an intentional action taken by an individual meant to harm another person that
results in injury, including to the individual.
(163) "Physical Restraint" means any manual
method or physical or mechanical device, material, or equipment attached to or
adjacent to an individual's body that the individual cannot remove easily,
which restricts freedom of movement or normal access of the individual to the
individual's body. Any manual method includes physically restraining an
individual by manually holding the individual in place.
(164) "Plan Year" means 12 consecutive months
from the start date specified on an authorized ISP or Annual Plan.
"Positive Behavior Support Plan" means
the document written by a behavior professional in accordance with OAR
that describes behavior supports used to reduce the frequency or
intensity of an individual's challenging behavior.
(166) "Positive Behavior Support Services"
mean the professional behavior services and behaviors supports, provided to
assist an individual with challenging behaviors. Positive behavior support
services are available through the Community First Choice state plan.
"Positive Behavior Theory and Practice"
means a proactive approach to behavior supports that:
(a) Is evidence-based and emphasizes the
development of functional alternative behaviors.
(b) Uses the least intrusive intervention
(c) Includes safeguards
to ensure abusive, punishing, or demeaning behavior supports are never
(d) Evaluates the
effectiveness of behavior supports based on behavior data.
(168) "Prescription Medication" means any
medication that requires a prescription from a physician before the medication
may be obtained from a pharmacist.
"Primary Caregiver" means:
(a) For a child, their parent, guardian,
relative, or other non-paid parental figure that normally provides their direct
care. In this context, the term parent or guardian may include a designated
(b) For an adult,
the person identified in an Individual Support Plan as providing the majority
of services and support for an individual in the home of the
"Primary Care Provider" means the health care provider who delivers day-to-day
comprehensive health care. Typically, the primary care provider acts as the
first contact and principal point of continuing care for an individual within
the health care system and coordinates other specialist care the individual may
"Private Duty Nursing"
means the State Plan nursing services described in OAR chapter 410, division
132 and OAR 411-300-0150
that are determined medically necessary to support a
child or young adult in their home.
(172) "PRN (pro re nata)" means the
administration of a medication to an individual on an 'as needed'
(173) "Productivity" as
defined in ORS
427.005 means regular
engagement in income-producing work, preferable competitive employment with
supports and accommodations to the extent necessary, by an individual that is
measured through improvements in income level, employment status, or job
advancement or engagement by an individual in work contributing to a household
Behavior Services" mean the positive behavior support services delivered by a
behavior professional in accordance with OAR chapter 411, division
(175) "Progress Note" means a
written record of an action taken by a provider in the delivery of a service to
support an individual. A progress note may also be a written record of
information related to services, support needs, or circumstances of the
individual that is necessary for the effective delivery of services.
"Protective Services" means:
(a) For an adult, "adult protective services"
as defined in ORS
to mean the necessary actions taken to prevent abuse or exploitation of an
adult, to prevent self-destructive acts and to safeguard an adult's person,
property and funds, including petitioning for a protective order as defined in
125.005. Any actions
taken to protect an adult shall be undertaken in a manner that is least
intrusive to the adult and provides for the greatest degree of
(b) For a child or
child in care, including a young adult in a residential program for children,
child foster home, or child-caring agency, "protective custody" as described in
ORS chapter 419B and "child protective services" as used in OAR chapter 413,
"Provider" means a person, agency, organization, or business, approved by the
Department or other appropriate agency and selected by an individual, or their
designated or legal representative, to provide Department-funded services. The
provider for a child may not also be the primary caregiver of the
means a public or private community organization that delivers developmental
disabilities services and is certified and endorsed by the Department under the
rules in OAR chapter 411, division 323 or division 450, that:
(a) Is primarily in business to provide
supports for individuals eligible to receive developmental
(b) Provides supports
for individuals through employees, contractors, or volunteers.
(c) Receives compensation to recruit,
supervise, and pay the people who actually provides support for the
"Provider Enrollment" means the agreement between the Department and a
qualified Medicaid provider to deliver services to a Medicaid eligible
individual for compensation.
"Provider Owned, Controlled, or Operated Setting" means:
The provider is responsible for
delivering home and community-based services to individuals in the setting and
(A) Owns the setting;
(B) Leases or co-leases the residential
(C) If the provider has
a direct or indirect financial relationship with the property owner, the
setting is presumed to be provider owned, controlled, or operated.
(b) A setting is not provider
owned, controlled, or operated if the individual leases directly from a third
party that has no direct or indirect financial relationship with the
(c) When an individual
receives services in the home of a family member, the home is not considered
provider owned, controlled, or operated.
(181) "Psychotropic Medication" means a
medication the prescribed intent of which is to affect or alter thought
processes, mood, or behavior including, but not limited to, anti-psychotic,
antidepressant, anxiolytic (anti-anxiety), and behavior medications. The
classification of a medication depends upon its stated, intended effect when
Practitioner" means a behavior professional who meets the qualifications
described in OAR chapter 411, division 304 or a health care provider who may
direct or prescribe the use of a safeguarding intervention or safeguarding
equipment within the scope of their professional role and expertise.
(183) "Quality Assurance" means a systematic
procedure for assessing the effectiveness, efficiency, and appropriateness of
Action" means the action a CME or OTIS determines as likely to prevent further
abuse or to minimize the risk of the future occurrence of a serious
(185) "Relief Care" means
the services provided on a periodic basis for the relief of, or due to the
temporary absence of, a person normally available to provide supports to an
individual. A unit of service of relief care is 24 hours. Relief care is
available through the Community First Choice state plan.
"Request for Service" means:
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.
(187) "Residency Agreement" means the written
and legally enforceable agreement between a residential provider and an
individual or their legal or designated representative, when the individual is
receiving home and community-based services in a provider owned, controlled, or
operated residential setting. The Residency Agreement identifies the rights and
responsibilities of the individual and the residential provider and provides
the individual protection from eviction substantially equivalent to
"Residential Program" means services delivered by the following:
(a) 24-hour residential programs described in
OAR chapter 411, division 325.
Adult foster homes described in OAR chapter 411, division 360.
(c) Supported living programs described in
OAR chapter 411, division 328.
Foster homes for children described in OAR chapter 411, division 346.
(e) Host home programs described in OAR
chapter 411, division 348.
(189) "Residential Setting" means the
location where individuals, who receive services from a residential program,
(190) "Review" means a
request for reconsideration of a decision.
"Safeguarding Equipment" means a device
that meets the definition of a "physical restraint", requires an
individually-based limitation consistent with OAR 411-415-0070
, and is used to:
(a) Maintain body position;
(b) Provide proper balance; or
(c) Protect an individual from injury,
symptoms of a medical condition, or harm from a challenging behavior.
means a manual physical restraint, applied by a designated person certified to
use the safeguarding intervention according to OAR 411-304-0160
(a) Has been authored by a behavior
professional as an emergency crisis strategy within a Positive Behavior Support
Has been consented to
through the individually-based limitation process consistent with OAR
Is used as an
emergency crisis strategy to protect an individual from:
(A) Harming themselves;
(B) Harming others; or
(C) When the individual's behavior is likely
to lead to intervention by law enforcement.
(193) "School Aged" means the age at which an
individual is old enough to attend kindergarten through high school.
(194) "Self-Administration of Medication"
means an individual manages and takes their own medication, identifies their
own medication and the times and methods of administration, places the
medication internally in or externally on their own body without staff
assistance upon written order of a physician, and safely maintains the
medication without supervision.
"Self-Determination" means a philosophy
and process by which individuals with intellectual or developmental
disabilities are empowered to gain control over the selection of services and
supports that meet their needs. The basic principles of self-determination are:
(a) Freedom. The ability for an individual,
together with freely-chosen family and friends, to plan a life with necessary
services and supports rather than purchasing a predefined program.
(b) Authority. The ability for an individual,
with the help of a social support network if needed, to control resources in
order to purchase services and supports.
(c) Autonomy. The arranging of resources and
personnel, both formal and informal, that assists an individual to live a life
in a community rich in community affiliations.
(d) Responsibility. The acceptance of a
valued role of an individual in the community through competitive employment,
organizational affiliations, personal development, and general caring for
others in the community, as well as accountability for spending public dollars
in ways that are life-enhancing for the individual.
(196) "Self-Direction" means an individual,
or as applicable their legal or designated representative, has decision-making
authority over services and takes direct responsibility for managing services
with the assistance of a system of available supports that promotes personal
choice and control over the delivery of waiver and state plan
Impairment" means loss or impairment of sight or hearing from any cause,
including involvement of the brain.
(198) "Serious Illness" means a physical
condition which, if left untreated, is likely to result in hospitalization or
bodily injury up to or including death.
"Serious Incident" means that one or
more of the following types of events has occurred:
(a) An act of physical aggression by an
(b) Death of an
(c) An individual
receives emergency medical care.
(d) The use of a physical restraint that is
not a safeguarding intervention.
(e) An individual is missing beyond the time
frame established in their ISP.
An individual is admitted to a psychiatric hospital.
(g) A safeguarding intervention or the use of
safeguarding equipment results in injury to an individual.
(h) An individual attempts suicide.
(i) An unplanned hospitalization of an
(j) A medication error
with adverse consequence.
(200) "Serious Injury" means bodily harm that
appears to pose a risk of imminent threat to life or limb and without
intervention, an individual is at risk of death or potential permanent lifelong
Means the component of an ISP that is the
written agreement for a particular provider that describes at a minimum, the
(A) The services authorized in an
ISP to be delivered by the provider.
(B) Hours, rates, location of services, and
expected outcomes of the services.
(C) Any specific individual health, safety,
and emergency procedures that may be required, including action to be taken if
an individual is unable to provide for their own safety and the individual is
missing while in the community.
(b) For employed personal support workers,
the Service Agreement serves as the written job description for Oregon Home
Care Commission purposes.
non-personal support worker providers, the ISP serves as the Service Agreement,
when signed by the provider.
(202) "Service Element" means a funding
stream to fund developmental disabilities programs and services.
(203) "Service Record" means the combined
information related to an individual.
(204) "Services Coordinator" means an
employee of the Department, CDDP, or other agency that contracts with the
county or Department, who provides case management services. A services
coordinator acts as the proponent for individuals with intellectual or
developmental disabilities and is the person-centered plan coordinator for the
individual as defined in the Community First Choice state plan.
(205) "Setting" means the community-based
location where services are delivered.
(206) "Sheltered Workshop" means a facility
in which individuals with intellectual or developmental disabilities are
congregated for the purpose of receiving employment services and performing
work tasks for pay at the facility. A sheltered workshop primarily employs
individuals with intellectual and developmental disabilities, or other
disabilities, with the exception of service support staff. A sheltered workshop
is a fixed site that is owned, operated, or controlled by a provider, where an
individual has few or no opportunities to interact with individuals who do not
have disabilities, not including paid support staff. A sheltered workshop is
not small group employment in an integrated employment setting and is not
otherwise an integrated employment setting.
(207) "Skills Training" means the hourly
service intended to increase the independence of an individual through
training, coaching, and prompting the individual to accomplish ADL, IADL, and
health-related tasks. Skills training is available through the Community First
Choice state plan.
Benefit" means that developmental disabilities services are intended to assist
an individual to function in society on a level comparable to that of a person
who does not experience a developmental disability.
Social benefits may not:
(A) Duplicate benefits and services otherwise
available to a person regardless of disability.
(B) Replace normal parental responsibilities
for the services, education, recreation, and general supervision of a
(C) Provide financial
assistance with food, clothing, shelter, and laundry needs common to any
person, except as described in OAR chapter 411, division 435 for transition
(D) Replace other
governmental or community services available to an individual.
(b) Assistance provided as a
social benefit is reimbursement for an expense previously authorized in an
(c) Assistance provided as a
social benefit may not exceed the actual cost of the support required by an
individual to be supported in the home of the individual.
(209) "Staff" means a paid employee who is
responsible for providing services and supports to an individual and whose
wages are paid in part or in full with funds sub-contracted with a Community
Developmental Disabilities Program, Brokerage, or contracted directly through
"Substantiated" means an abuse investigation has been completed by the
Department, or the designee of the Department, and abuse was
(a) For a child, the assistance the child and
their family requires, solely because of the effects of a condition that makes
the child eligible for developmental disabilities, to maintain or increase the
age-appropriate independence of the child, achieve age-appropriate community
presence and participation of the child, and to maintain the child in the
family home. Support is subject to change with time and
(b) For an adult,
the assistance the adult individual requires, solely because of the effects of
an intellectual or developmental disability, to maintain or increase
independence, achieve community presence and participation, and improve
productivity. Support is subject to change with time and
"Temporary Emergency Safety Plan" means a document outlining the behavior
supports and environment thought by a behavior professional to be necessary to
support an individual exhibiting challenging behavior prior to the completion
of a Functional Behavior Assessment and Positive Behavior Support
(213) "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.
(a) Not older than 24
years of age.
(b) Not younger than
14 years of age. With respect to Vocational Rehabilitation Services, persons
who are under 16 years of age may receive employment services with Department
approval. With respect to ODDS, persons who are under 18 years of age may
receive employment services with Department approval.
"Unacceptable Background Check" means
an administrative process that produces information related to the background
of a person that precludes the person from being an independent provider for
one or more of the following reasons:
Under OAR 407-007-0275
, the person applying to be an independent provider has
been found ineligible due to ORS
Under OAR 407-007-0275
, the person was
enrolled as an independent provider for the first time, or after any break in
enrollment, after July 28, 2009 and has been found ineligible due to ORS
A background check and fitness
determination has been conducted resulting in a "denied" status as defined in
"Variance" means the temporary exemption from a regulation or provision of the
rules granted by the Department upon written application.
(217) "Volunteer" means any person assisting
a provider without pay to support the services and supports provided to an
(218) "Workday" means
12:00 AM through 11:59 PM.
"Working Age" means an individual aged 21 to 60. Working age also includes an
individual 18 to 21 if the individual has left school.
(220) "Workweek" means 12:00 AM Sunday
through 11:59 PM Saturday.
"Written Outcome" means the written response from the Department or the local
program to a complaint following a review of the complaint.
(222) "Young Adult" means an individual aged
18 through 20.